Hormone Replacement Therapy (HRT)

Hormone Replacement Therapy (HRT)

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Hormone Replacement Therapy (HRT)

HRT is used during the menopause to ease classic symptoms such as night sweats, hot flushes, and vaginal dryness. It’s made up of two sex hormones - oestrogen and progesterone.

Most women take HRT daily in tablet form, either cyclically or continuously. Cyclic HRT is generally the favoured route of treatment, recommended for women that are still having periods, whilst continuous use is more for women who are post-menopausal but still experiencing symptoms.

HRT has been a subject of controversy in the past, when studies in the 1990s showed a marked increase in the risk of developing breast cancer. However, we now know that this risk is only small, though women with a history of breast cancer are advised against the treatment.

HRT has also been shown to reduce the risk of osteoporosis in menopausal women, benefitting their health in more ways than one. HRT can greatly improve a woman’s quality of life when going through the menopause, but talking to your GP first is essential, as it isn’t always the most suitable treatment.

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HRT is a popular treatment for symptoms of the menopause. The hormones are similar to those used in contraceptive pills, but are less potent. Women often report an increased quality of life whilst on the medication, and symptoms such as hot flushes, night sweats, mood swings and vaginal dryness are reduced. It’s important to speak to your GP about starting treatment though, as HRT isn’t suitable for everyone, for example, women with a personal or family history of breast cancer.

HRT for the Menopause

What is HRT?

HRT stands for hormone replacement therapy, and it pretty much does what it says on the tin. The medication is used to replace the hormones oestrogen and progesterone in women when the body doesn’t produce enough during menopausal years.

Every woman goes through the menopause, and many struggle with the symptoms it can bring such as night sweats, hot flushes, vaginal dryness and thinning bones. HRT can alleviate many of these symptoms and given struggling women a better quality of life. HRT comes in various forms, most commonly as a tablet taken daily, but lesser-known options include patches, gels and vaginal creams, pessaries and rings.

How do I take HRT?

Your method of taking HRT depends on both the form you’re using, and your doctor’s advice on whether you should take it cyclically (typically monthly or 3-monthly) or continuously. This means that you may be taking oestrogen all the time, but only using progesterone at set periods throughout the month/s. This is generally recommended for women that are still having periods, and continuous use is more common for post-menopausal women.

Most women will be prescribed a combination of oestrogen and progesterone, as oestrogen on its own can increase your risk of womb cancer. Progesterone mitigates this risk, but may not be necessary for women without a womb, for example, those who’ve had a hysterectomy.

Some people believe that you can only stay on HRT for a certain amount of time, but the truth is that there isn’t a limit that says when you need to stop. General guidelines recommend that a woman is given the lowest dose effective for the shortest time possible, but if your symptoms last for several years and the medication improves your quality of life, you shouldn’t be asked to stop taking it.

When you decide to come off HRT, you can either stop treatment suddenly, or taper off the medication. Tapering is generally the preferred method of stopping treatment as this is more likely to prevent symptoms from returning.

Daily tablets are the most common form of HRT, with most women’s symptoms improving within a few weeks, but recent research shows that this might not be the most ideal form of taking the medication. Tablets carry risks such as blood clots and DVT, but other methods such as gels and transdermal patches don’t. It’s worth taking a look at all of the available options to see which one suits you best.

Another form of HRT comes in the form of the IUS. This is placed inside the uterus where it releases progesterone (so you may still need oestrogen in some form). Many women use the same device for contraception, and for treatment of the menopause, it can be left in for up to 4 years.

What are the side effects of HRT?

You might find that you experience some side effects whilst on HRT, especially as the medication is hormonal. The most commonly reported ones are:

  • Tender breasts
  • Headaches
  • Nausea
  • Abdominal pain
  • Vaginal bleeding

Most women who experience these symptoms find them bearable, but if you find they’re worse than the symptoms of the menopause, contact your GP who may suggest stopping treatment or lowering your dosage.

As mentioned before, certain types of HRT such as tablets can also cause blood clots in some cases, so make sure you know which options are available to you so you can make an informed decision.

Even if you aren’t experiencing side effects, your doctor will monitor you periodically, usually once a year to see how you’re getting on with the medication and whether it’s still suitable or even necessary for you to be taking it.

Can I get pregnant whilst on HRT?

Despite the fact you’re going through the menopause, it’s still possible to get pregnant if you’re still having periods, no matter how irregular they are. As long as your ovaries are still releasing eggs, you may still be able to conceive. HRT isn’t the same as contraception despite using similar hormones to those that are in birth control pills, so if you’re not wanting to become pregnant, you’ll still need to use contraceptive methods such as condoms until you’re post-menopausal. You’re classed as post-menopausal if you haven’t had a period in 12 months.

Can HRT cause breast cancer?

It is true that HRT can increase your risk of breast cancer, but the NHS states that this increase is only small, and that the benefits of the medication can far outweigh the risks when used as a short-term treatment. However, if you have a personal or family history of breast cancer, it isn’t advised that you use HRT for treatment of the menopause as there are other options that don’t carry the same risks.

If you don’t have a history of it, it’s still advised that you attend all of your breast screenings when called for. Even though the risk isn’t much higher than those who don’t take HRT, it’s still there, so precautionary measures such as screenings are always a good idea to make sure you’re well.

When you come off HRT, any increased risk of breast cancer is reversed over a period of time.

When should I start HRT?

When you first start noticing symptoms that bother you, you should have a chat with your doctor about beginning treatment. Some women leave it until their symptoms are unbearable and debilitating before seeking help, but some evidence suggests that starting HRT when you first notice symptoms can actually reduce your risk of osteoporosis. However, if you aren’t experiencing bothersome symptoms, it isn’t recommended that you start hormone replacement treatment.

Will HRT make me gain weight?

In short, no. There’s no evidence to suggest that HRT will make you gain weight. However, there’s nothing to say that you won’t put a few extra pounds on, but this has much more to do with the menopause than the hormone replacement therapy. There may be a chance that it could cause water or sodium retention though, which some people mistake for weight gain. It’s recommended that you take part in regular exercise and eat a healthy, balanced diet, as is advised with people of all ages, but you may need to be extra careful as you get older.

Will HRT delay the menopause?

No, HRT isn’t a preventative, but it will help to alleviate your symptoms whilst you go through the process. The menopause is natural and happens to every woman, so it can’t be prevented like infections or diseases can be. Women are born with a finite amount of eggs, so when these start running out, you will go through the menopause whether you take HRT or not.

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